Wire guides are used during many medical procedures in the gastrointestinal system, including the pancreatobiliary system (i.e., the biliary tree), the stomach, and the esophagus. During vascular procedures, such as balloon angioplasty, stent placement, and endoluminal grafts for aortic aneurysms, the use of wire guides are essential in assessing the site of the particular obstruction in the affected artery. Wire guides are long, slender, relatively flexible wires or wire-like elongate devices that are used to gain and maintain access to the body's narrow passageways during minimally invasive medical procedures. Because of the substantial length of wire guides, using wire guides can be cumbersome and require constant, delicate manipulation during time-sensitive medical procedures.
Wire guides often must be maintained in a stationary position relative to the patient while a physician performs various procedures. In particular, maintaining the wire guide in a stationary position is important to prevent loss of access to a target anatomy, for example, a duct in the biliary tree. Also, during an esophageal dilation, a physician must secure a wire guide within the esophagus and across an esophageal stricture as one or more dilators are advanced over the wire guide. Likewise, during a percutaneous endoscopic gastromy (PEG) tube placement, a wire guide must be secured relative to the patient's mouth, esophagus, and stomach as a physician inserts a feeding tube.
Due to the complexity of these types of procedures, physicians often need to maneuver the wire guide during medical procedures. However, due to the difficulty in grasping the wire guide, the task of positioning and maneuvering the wire guide generally requires the help of an assistant to grip and manipulate the wire during usage. The difficulty associated with positioning and maneuvering the wire guide, however, tends to shift the focus of the assistant from their other areas of responsibility, such as checking the patient, checking monitors for relevant information, or carrying out other tasks.
As a way of simplifying procedures involving wire guides, devices have been developed to assist in the positioning and maneuvering of the wire guide during medical procedures. One such known wire guide device includes a cylindrical body and a slot extending longitudinally for the entire length of the device for side loading of the wire guide therein. The device further includes two biased closed jaws on either side of the slot and two compression handles for opening the jaws. A problem with this device is that when rotating the device for torquing the wire guide, one of the compression handles may be pressed inadvertently. As a result, the jaws may separate and inadvertently release the wire guide. Another problem with this device is that the slot extends the entire length of the device. Thus, during use, the smooth, cylindrical proximal end of the wire guide may slide out from between the jaws and thereby exit the slot of the device.
Another known device includes pin-vise type wire grips that include a structure similar to a drill chuck with a cylindrical handle. The chuck is threaded over the proximal end of the wire guide and advanced to a desired position. A chuck collet, which is a part of the pin-vise, is then rotated to secure the pin-vise to the wire guide and serves as a grip to facilitate manual rotation and advancement of the wire guide. However, use of this type of device can become time consuming and inconvenient because of the length of the wire guide and time associated with threading the device onto the wire guide, as well as the time associated with tightening the chuck collet.
Another known wire guide device utilizes a locking nut portion that locks onto the wire when turned in one direction and releases when turned in the opposite direction thereby requiring the physician to utilize two hands when locking an unlocking the device to the wire guide. Additionally, it may be necessary to completely remove and reinsert the wire guide into this type wire guide device during positioning and maneuvering of the wire guide. As a consequence, maneuvering of the wire guide can become time consuming and distracting to the physician during complicated medical procedures.
What is needed is a wire guide torque device that can quickly and easily engage the wire guide, requires minimal effort to lock and unlock to the wire guide during usage, and allows a physician to operate the device using one hand during positioning and maneuvering of the wire guide. Also, the wire guide torque device should require minimal time and effort to operate during medical procedures.